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Comparison of Flexible and Navigable Suction Ureteral Access Sheath Versus Conventional Ureteric Access Sheath in
Ankur Mittal1, Anumanchi Dattasai Subramanyam1, Vikas Kumar Panwar1
1Department of Urology, All India Institute of Medical Sciences, Rishikesh, India.
Objective:
To evaluate the efficacy and safety of flexible and navigable suction ureteral access sheath (FANS) versus conventional ureteric access sheath (C-UAS) in Retrograde Intrarenal Surgery (RIRS) for renal stone disease through meta-analysis and trial sequential analysis (TSA). The FANS technology has emerged as a potential solution, incorporating active suction mechanisms to enhance stone clearance and visualization.
Methods:
PubMed, EMBASE, Cochrane, and Scopus were searched from 2000 to June 2025 for randomized controlled trials (RCTs) and prospective studies comparing FANS vs. C-UAS in adult RIRS. The primary outcome was stone-free rates at various time points; secondary outcomes included complications, operative, and recovery parameters. The risk of bias was assessed, and random-effects meta-analyses with subgroup, meta-regression, TSA, and Bayesian modeling were performed.
Results:
Fifteen studies comprising 11 RCTs and 4 observational studies with 3030 participants were included. Flexible and navigable suction ureteral access sheath achieved a significantly higher immediate stone-free rate (79.1% vs. 54.5%; Relative Risk (RR): 1.47, 95% CI: 1.23-1.7; P < .001). Significant heterogeneity was noted (I2 = 89.3%). The absolute risk difference was 24.6% (number needed to treat = 6). Stone-free rates favored FANS at 30 days (93.5% vs. 82.7%; RR = 1.13) and 3 months (96.2% vs. 88.4%; RR = 1.09), both statistically significant. Flexible and navigable suction ureteral access sheath reduced overall complications by 52% (9.7% vs. 20.2%). Benefits were greatest for stones >20 mm (RR = 2.14), density ≥1000 HU (RR = 1.94), and non-pre-stented patients (RR = 1.37). Trial sequential analysis (3030 patients; 106.4% information size) confirmed FANS superiority. Machine learning prediction of stone-free success showed high accuracy (Area Under the ROC Curve [AUC] = 0.89).
Conclusion:
Flexible and navigable suction ureteral access sheath shows clear superiority, improving immediate stone-free rates by 47% with notable safety benefits, TSA confirms evidence sufficiency. Cite this article as: Mittal A, Subramanyam AD, Panwar VK, Malhotra K, et al. Comparison of flexible and navigable suction ureteral access sheath versus conventional ureteric access sheath in RIRS: A systematic review and meta-analysis. Urol Res Pract. 2026, 52, 0119, doi:10.5152/tud.2026.25119.
